Pelvic pain is commonly seen symptom in women. It can be acute (comes suddenly and severely) or it could be recurrent lasing for months. If it lasts for longer time and it is interfering with your day to day life, it requires attention. There can be an underlying condition causing pelvic pain.

Sudden, unexpected (acute) pelvic pain can be due to ovarian cyst rupture, torsion or haemorrhage within the cyst, urinary infection, appendicitis or pelvic inflammatory disease. Sometimes chronic conditions like endometriosis can cause acute pain. It does require an urgent attention. You may have to attend your doctor’s surgery or accident and emergency department for that.

Long-term (chronic) pelvic pain

If you've had pelvic pain for 6 months or more that either comes and goes or is continuous, it's known as chronic pelvic pain. It is more intense than ordinary period pain and lasts longer. It affects around 1 in 6 women.

What are the potential causes of Chronic Pelvic Pain?

The potential reasons are endometriosis or adenomyosis, chronic pelvic inflammatory disease, irritable bowel syndrome, recurrent urinary infections, recurring ovarian cysts, Uterovaginal prolapse. Rarely degenerating fibroids, chronic interstitial cystitis (inflammatory bladder condition), inflammatory bowel disease (IBD) like ulcerative colitis and Crohn's disease or nerve entrapment can cause similar pain.

How is this condition managed?

First of all it is important to establish a diagnosis. Most important tools to get to the diagnosis are;

• Detailed history taking
• Clinical assessment
• Pelvic ultrasound scan
• MRI or CT scan in some cases
• Invasive endoscopic procedures like laparoscopy, cystoscopy

Remaining treatment depends on the cause but overall, lifestyle changes, coping strategies along with targeted treatment towards the cause is planned.

Please contact to make an appointment.

This is a one stop service specifically designed for women with acute or chronic pelvic pain, abdominal pain, menstrual problems (heavy, irregular or painful periods) ovarian cyst or any other potential gynaecological problems.

What does this appointment involve?

Your appointment includes detailed discussion about your symptoms (history taking), gynaecological examination (which is more likely to be an internal examination), pelvic scan and discussion regarding further treatment options. In most cases all this can be done in the same appointment though after listening to your problem if it is felt that you may not require a scan, I will discuss this with you. If you require any other investigations, I will discuss that with you.

The intention is to give you a potential diagnosis and start you on the initial treatment in your fist appointment.

Possible reasons to have a pelvic scan:

You may wish to consider this appointment if you have: pain, bloating, abnormal blood tests, to asses for abnormal growths e.g. tumours, discomfort, irregular or erratic vaginal bleeding, irregular or erratic periods, spotting between periods, painful / heavy periods, post-menopausal bleed. It is used to detect fibroids or cysts and assess for polycystic ovaries (PCO), polyps, coil (IUD) position, possible cause for painful sexual intercourse, possible pelvic inflammatory disease and endometrial thickness and abnormality. It is also useful to assess effects of hormone replacement therapy.

What are we looking for?

The purpose of the pelvic ultrasound scan is to assess the major female pelvic organs including Uterus, thickness and condition of the lining of the womb (endometrium), ovaries and adnexa (area around the womb). I will also be looking at subtle changes to diagnose possible causes of pain by checking mobility of different organs and areas that may elicit pain.

How is this clinic different than other scan clinic?

This clinic is aimed at looking at all aspects of your problem, giving you a diagnosis and starts you on treatment in one sitting. Though it is not possible in all cases, in most cases we can achieve it.

How much does this cost?

The first consultation cost varies between £ 130.00 to 180.00 for consultation depending on either you are self-pay or insured and the insurance company you belong to.

The scan fees vary between £ 100.00 to 200.00 depending on same criteria as above.

Try to make your appointment once we know your status, we will be able to tell you about the exact fees.

Contact us to know the exact fees, so that we can discuss.

If you require any further investigations, it will cost extra but you will be informed about it and options will be given. If you are privately insured, fees will vary depending on your insurer but that is paid by your insurance company.

Please contact to make an appointment.

What is endometriosis?

It is a long term condition where cells that normally line the womb (called the endometrium) are found elsewhere, usually in the pelvis around the womb, ovaries and fallopian tubes. It is not cancer and it is not infectious. It is a very common condition, affecting between 2 and 10 women out of 100. You are more likely to develop endometriosis if your mother or sister has had it.

It is common during reproductive years. It can have a significant impact on your general physical health, emotional wellbeing and daily routine.

The exact cause of endometriosis is not known. It is thought to happen when cells that line the womb are carried to the pelvis via the fallopian tubes during your period. These cells respond to your hormones and bleed. This can cause pain, inflammation and possibly damage to your pelvic organs.

Endometriosis may be found on the ovaries, where it can form cysts (often referred to as ‘chocolate cysts’), in or on the fallopian tubes, around the womb, in the area between the vagina and the rectum and in the peritoneum (the lining of the pelvis and abdomen). Endometriosis can also occur within the muscle wall of the womb (adenomyosis) and occasionally on the bowel and/or bladder. It may sometimes be found in other parts of the body, but this is rare.

Symptoms

What are the symptoms?

Some women with endometriosis do not have any symptoms. In symptomatic women, it causes symptoms in a cyclical fashion, becoming worse before and during the periods. Some women experience pain all the time but for others it may come and go.

Common symptoms:

• Pelvic pain
• Painful, irregular or heavy periods
• Pain during or after sex
• Pain related to your bowels, bladder, lower back or the tops of your legs, and experience long-term fatigue.

Diagnosis

• History suggestive of cyclical symptoms as mentioned above though not in all cases pain is just before and during menstruation. It can vary and can be constant.
• Diagnostic tests:
  • Pelvic ultrasound scan: This is a transvaginal scan to check the uterus and ovaries. It may show whether there is an endometriotic (chocolate) cyst in the ovaries or may suggest endometriosis between the vagina and rectum. It also allows to “pain map” to give an idea about potential areas where endometriosis is likely. Click here if you wish to arrange a pelvic ultrasound scan.
  • Diagnostic Laparoscopy: this is a diagnostic as well as a treatment. This is carried out under a general anaesthetic. Small cuts are made in your abdomen and a telescope is inserted to look at your pelvis. If an endometriosis is found, it can be treated by removing cysts on the ovaries or treating any areas on the lining of your pelvis.
  • An MRI scan may be suggested if the condition appears to be advanced.

Treatment

There are number of treatment options.

• Pain-relieving medications. This can range from over-the-counter remedies to prescribed medications from your health practitioner. In more severe situations, you may be referred to a specialist pain management team.
• Hormone treatments: The aim is to reduce your ovarian function which allows the endometriosis to shrink or disappear. The hormone treatments offered could be;
  • the combined oral contraceptive (COC) pill or patch given continuously without the normal pillfree break; this usually stops ovulation and temporarily either stops your periods or makes your periods lighter and less painful
  • an intrauterine system (IUS/Mirena®), which helps to reduce the pain and makes periods lighter; some women using an IUS get no periods at all
  • progestogens in the form of injection, the mini pill or the contraceptive implant.
  • GnRHa (gonadotrophin-releasing hormone agonists), which are given as injections, implants or a nasal spray. They are very effective but can cause menopausal symptoms such as hot flushes and are also known to reduce bone density. To help reduce these side-effects and bone loss, you may be offered ‘add-back’ therapy in the form of hormone replacement therapy (HRT).
• Surgery: Most of the time laparoscopic surgery is offered to treat endometriosis. It will depend on where the endometriosis is and how extensive it is. This may be done when the diagnosis is made or may be offered later. Success rates vary and you may need further surgery. For more severe cases laparotomy is offered. Sometimes other surgeons, such as bowel specialists, will be involved.

If needed, a laparotomy can be used to remove the ovaries with or without performing a hysterectomy (removing the womb). You will not be able to have children after a hysterectomy. Longer term pain relief is more likely if your ovaries are removed but you may require hormone replacement therapy (HRT) after that.

Contact if you wish to have a scan to diagnose the condition and have a treatment for your pelvic pain.